Summary
New research from the Employee Benefit Research Institute (EBRI) finds that where patients receive physician-administered medications can have a major impact on health care spending in employer-sponsored health plans. An analysis of commercial insurance claims for high-cost outpatient medications found that hospital outpatient departments are often reimbursed substantially more than physician offices for administering the same drugs.
The study examines physician-administered treatments used for cancer, autoimmune diseases, multiple sclerosis, inflammatory conditions, rare diseases, and other serious chronic illnesses. Researchers explored how reimbursement varies by site of care and assessed the potential implications for employers, health plans, workers, and policymakers.
The findings contribute to growing national discussions around site-neutral payment policies, health care affordability, employer health benefit costs, and strategies to reduce unnecessary spending while maintaining access to clinically appropriate care. The report highlights the role of provider consolidation, contracting practices, network design, and reimbursement policies in shaping treatment costs across care settings.
For employers, health plans, and policymakers seeking solutions to rising health care costs, the research offers evidence that addressing reimbursement disparities between treatment settings may represent a significant opportunity to improve efficiency in the U.S. commercial health insurance market while supporting long-term affordability for covered workers and families.